Working Protocol between the Practitioner Health Programme and the National Clinical Assessment Service Purpose of this document 1. The purpose of this document is to provide practical guidance on how the Practitioner Health Programme (PHP) and the National Clinical Assessment Service (NCAS) will communicate, given their distinct roles and functions. This document sets out some general principles and is not intended as a mechanism for the routine sharing of information. 2. The document sets out a protocol for the sharing of information in relation to the core functions of each organisation, that is, in the case of the PHP seeing and treating individual doctors and dentists, and for NCAS advising employers, contracting organisations and individual practitioners in relation to performance difficulties. It does not cover the commissioning/performance management role of NCAS with regard to the PHP, through which PHP is accountable to the Department of Health. Practitioner Health Programme 3. The PHP1 will provide advice, assessment, treatment and case management services for doctors and dentists living or working in London. Where necessary, they will arrange onward referral to specialist services (PHP2). Practitioners accessing the PHP will have health concerns that relate to: a mental health or addiction problem (at any level of severity) and/or a physical health problem (where that physical health problem may impact on the practitioner s performance). 4. Health care organisations may seek advice or make referrals. Colleagues, family and friends of practitioners with health concerns may also contact the service for advice. National Clinical Assessment Service 5. NCAS (previously known as the National Clinical Assessment Authority) was established as a special health authority in April 2001 and became an operating division of the National Patient Safety Agency (NPSA) on 1 April 2005. NCAS is a clearly defined service within the NPSA with a Medical Director who carries responsibility as its Chief of Service. NCAS has offices in Wales, Northern Ireland and Scotland. 6. NCAS promotes public confidence in doctors, dentists and pharmacists by helping to address concerns about the performance of individual medical and dental practitioners. It 1
provides confidential support to health care organisations in managing practitioners whose performance gives cause for concern. If a concern comes to light, the employer/contracting body, or the practitioner themselves, can contact NCAS for help. NCAS aim is to work with all parties to clarify the concerns and make recommendations to help the practitioner continue to deliver a high quality and safe service for patients. It does this by providing advice, support and, where indicated, by offering to undertake performance assessments. Confidentiality for individual practitioners 7. Practitioners accessing the PHP will need to be assured that all information about them is treated in the strictest confidence. This duty is set out in the PHP confidentiality policy which is published on their website (Annex A). The policy covers the rare occasions where disclosure to a third party without the consent of the practitioner may be required. 8. NCAS also deals with sensitive, personal data and is aware of the need to protect, as far as possible, the confidentiality of the practitioners and the organisations with whom they work. At the same time, both PHP and NCAS need to be able to share sufficient information where necessary (or required) in the public interest and in accordance with their respective functions. 9. Details of the legal framework governing information sharing and its implications for collaboration between NCAS and the PHP can be found at Annex B of this document. Liaison on case handling between NCAS and PHP 10. There may be some cases where a discussion is required between NCAS and the PHP prior to an NCAS Adviser suggesting to a Trust or Primary Care Trust (referring body RB ) that it considers seeking advice from or referring to the PHP. The purpose of the discussion is to establish whether PHP is the most appropriate body to deal with the case. Such discussions will not identify the practitioner or the employing or contracting organisation. 11. Where an Adviser suggests to an RB that they advise referral to PHP, the Adviser will continue to advise the RB on the handling of the case. Indications for self-referral by practitioner to PHP or referral by RB 12. The following are examples of indications for an RB to consider advising a practitioner on self-referral to PHP or themselves making a referral to PHP: Where there is concern about a possible health problem Where the practitioner has gone through local occupational health/specialist referral and the problem is not resolved or the way forward has not been clarified For access to specialists with expertise in accessing a particular condition in doctors (e.g. cognitive impairment, alcohol, depression, autistic spectrum disorders) Where the health problem is complex perhaps with multiple co-morbidity Where specialist help with regard to a practitioner s health is required with a return to work programme. 13. NCAS will advise an RB accordingly and will normally advise an RB to make any referral to PHP through their occupational health department. While PHP is not an occupational health service it may provide valuable additional specialist advice to local OH. 2
14. Normally PHP can only see doctors or dentists who live or work in the London area (within the M25). PHP advising on contact with NCAS 15. Where a Trust or PCT refers a practitioner to the PHP, PHP may advise them (in addition) to contact NCAS if PHP and/or the Trust has concerns about the impact of the practitioner s health on their performance in the work place such that management action may need to be taken (e.g. investigation, restriction of duties, referral to regulator) or want advice on accessing an assessment of performance of a practitioner or want NCAS advice in preparing a return to work programme, for example, where monitoring of performance or a behavioural or health contract is required. 16. It is not PHP s role to advise an RB directly about managing the performance aspects of the case. 17. If a practitioner self-refers to PHP and PHP has concerns about the impact of the practitioner s health on their performance in the work place, the PHP will normally seek consent from the practitioner to contact their employing or contracting organisation. If this is provided, PHP will then advise the trust or PCT to seek advice from their occupational health service and, where appropriate, NCAS if they want help with managing the impact of the practitioner s illness in the work place. Where the practitioner does not consent to PHP contacting an employer and PHP has concerns about patient safety they will consider whether they have a duty to disclose to the RB or regulator (see PHP website (www.php.nhs.uk) reference to Memoranda of Understanding with GMC, GDC). 18. The PHP may also wish to contact NCAS for advice where the practitioner has been suspended by the regulatory body or RB and help is required for the RB and/or the practitioner in handling the case, in particular to minimise any adverse impact of the disciplinary/regulatory proceedings on the practitioner s health. 19. PHP may contact NCAS directly to check whether NCAS is in a position to advise a practitioner or an RB on the performance aspects of a case. Contact will be on an unnamed basis. Having sought NCAS advice, PHP will, in turn, advise the practitioner or employer or contracting organisation on making a direct approach to NCAS. Once they have done so, it may be helpful for PHP or NCAS to facilitate the convening of a case conference with relevant parties to consider all key? aspects of the case and how a way forward can best be achieved. Sharing of learning 20. The PHP and NCAS are both in a position to collect and publish information about patterns and trends in practitioners health. Neither PHP nor NCAS will publish any identifiable, personal data. 21. Both bodies will ensure that they share any published activity data in a timely way. If data or information about patterns of trends arise outwith routine publication schedules, both bodies will take steps to share that information as early as possible, usually prior to publication. Information will be shared only if it is consistent with both bodies data release rules and their legal obligations. 22. Both bodies publish evaluation reports on their work. Where these are likely to be mutually beneficial, copies of the reports will be shared as early as possible, usually prior to publication. 3
23. Both bodies undertake research and development work and will keep in contact to ensure that appropriate opportunities for joint work can be exploited. This may, for example involve sharing information about approaches to practitioners with health difficulties. Training and education 24. Both PHP and NCAS have roles and responsibilities in the training and development of health care organisations in handling health concerns in health practitioners. These provide opportunities for working together on training and development activities, which both are committed to following through. This may include invitations to attend or speak at national and regional events and conferences run by either organisation, help with induction training within either organisation, identifying opportunities for sharing platforms at external speaking engagements, and the preparation of joint articles and case studies. Subject access requests 25. Any subject access requests made to PHP and/or NCAS on cases which PHP and NCAS have in common will be handled by each organisation separately. Making public announcements 26. From time to time, both organisations make public announcements about their work. Where such announcements are likely to have an impact on the other organisation, advance warning of the announcement will be given, and any part of the announcement which refers to the other body or impacts on its work or function will be discussed in advance. 27. PHP and NCAS casework are both confidential, and neither organisation will comment publicly on individual cases referred, even to the extent of confirming whether or not it is involved. Contact details 28. See Annex C. Review 29. This document will be reviewed every three years or as necessary. SIGNATORIES Alastair Scotland Director National Clinical Assessment Service Clare Gerada Medical Director Practitioner Health Programme Date Date 4
ANNEX A London Prototype NHS Practitioner Health Programme (PHP) - Confidentiality Policy Commitment to confidentiality for practitioners using the PHP 1. Doctors and dentists should be assured that the Practitioner Health Programme (PHP) is a confidential service and that those being treated in the programme can expect the same level of confidentiality as all other patients. This means that the PHP will not disclose information to any third party without the consent of the practitioner, unless required by a legal obligation. Medical and dental practitioners will not be subject to a more or less stringent interpretation of the law than the general population. 2. This document sets out the commitment of the Practitioner Health Programme to confidentiality and the necessary limits to confidentiality. More information is provided in the Memoranda of Understanding with the General Medical Council and the General Dental Council which are available on the PHP website (www.php.nhs.uk). Security of patient records 3. All information (paper-based and electronic) about a practitioner will be kept in the PHP secure clinical system and accessed only by PHP clinical staff. All paper records will be scanned into a secure electronic record and the paper version destroyed. 4. Records will not be available through any record sharing arrangements such as the NHS Spine. Copies of electronic records will not leave PHP premises and back up data will also be held on site. 5. Information will be shared between PHP1 and PHP2 preferred providers only through secure systems. Providing identifying information 6. Where an individual contacts the service to seek information or advice, this will be provided regardless of whether they provide identifying information about themselves or the practitioner about whom they call. 7. Where a practitioner needs to be seen by the PHP (either PHP1 or PHP2) for assessment or treatment, identifying information must be provided. Contact with employers 8. The PHP will seek consent from the practitioner if they wish to make contact with their employer/contracting organisation to gather information or where liaison with local health services is required. 9. There will be no requirement on the practitioner to disclose to their employer (or a prospective employer) that they have attended the PHP unless they have been referred by the employer. In that case, consent for information to be disclosed will be sought. Evaluation of PHP and activity reporting 10. Evaluation of the PHP will be vital to assess the effectiveness of the service and consider how it can be improved. The PHP will be required to provide high level anonymised information about patterns of activity, types of cases seen, onward referral and outcomes. As part of this evaluation the views of practitioners using the service will be sought. No 5
information that may be attributed to named individuals will be included in any activity reporting or evaluation. Exceptions to the duty of confidentiality 11. There are exceptions to the duty of confidentiality that may require the use or disclosure of confidential information. Experience in other Practitioner Health Programmes has demonstrated that such exceptions are very rare and should not undermine the trust that the practitioner can place in the service. Public interest 12. Rarely, disclosure in the public interest may be required. This will be in those circumstances where the practitioner s health raises serious concerns about their own safety or the safety of their patients or the public. This will normally be limited to those cases where they are not complying with assessment, treatment or monitoring, or heeding advice to remain on sick leave. 13. In these cases PHP will seek consent from the practitioner but where consent cannot be achieved and the public interest is paramount, disclosure may be made without consent. In such a case the practitioner will be informed that disclosure has occurred and the reasons for doing so. Disclosure will be kept to the minimum required for the purpose and passed only on a need to know basis. Other requirements for disclosure 14. Other circumstances where disclosure may be required include cases where a. there is a legal requirement to disclose b. a formal referral has been made to the PHP by an employer or contracting organisation, the National Clinical Assessment Service or the regulatory body, or c. where the regulator requires reports from the PHP about a practitioner s health. 15. Again, the practitioner s consent will be sought and disclosure kept to a minimum to satisfy the requirements. 6
ANNEX B The Law Sharing information i) The legal framework governing information sharing includes obligations under the Data Protection Act 1998, the Human Rights Act 1998 and the common law duty of confidence. Where any information about individuals is shared between PHP and NCAS, both organisations will act in accordance with their legal obligations. This section sets out guidance on the law and is not intended to be a substitute for legal advice. ii) iii) iv) Where possible, NCAS and the PHP will endeavour to obtain the practitioner s and the referring organisation s explicit consent before sharing personal information between the two organisations. Whilst it is always the preferred option to share with explicit consent there will be exceptional circumstances when it may be lawful to disclose relevant information without consent where this falls within one of the exemptions laid out in the DPA or common law. Disclosure of information provided in confidence is permitted without consent on the grounds of overriding public interest such as patient safety, or for example where it may jeopardise other investigations which are themselves in the public interest. The most relevant reason being that NCAS or the PHP cannot perform its functions unless it is able to share/obtain this information. Any decision to share information without explicit consent will be made only once the individual circumstances haven been considered on a case by case basis in accordance with the law. v) NCAS and the PHP may also share personal information without explicit consent if the case can be successfully anonymised, that is the individual cannot be identified. vi) Where information is exchanged, requests and the response should be recorded and the disclosure of information will be authorised by a designated member of staff. Where information is shared without express consent obtained, the reasons for doing so should be clearly recorded. Responsibility for recording rests with the person providing the information. Fair processing information vii) viii) Generally, individuals should be told who is responsible for the processing of their personal data, what information is held about them and how this is being used or shared between organisations, as well as anything else in that particular case which make the processing fair (which all together constitute the Fair Processing information). In certain circumstances, section 31 of the DPA provides that fair processing information does not need to be provided to a data subject where the provision of the information would prejudice the discharge of a number of specified functions. Whether such prejudice would be likely to occur needs to be considered on a case by case basis. The disclosing party will be responsible for ensuring that the requirements of the law have been met. 7
ANNEX C Principal contacts - NCAS Dr Neil Margerison, NCAS Adviser Phone 020 7062 1652 neil.margerison@ncas.npsa.nhs.uk Richard Seppings, Senior Adviser, NCAS Phone 020 7062 1662 richard.seppings@ncas.npsa.nhs.uk Claire McLaughlan, Senior Adviser (Remediation, Reskilling and Rehabilitation), NCAS Phone 020 7062 1692 claire.mclauglan@ncas.npsa.nhs.uk Dr Rosemary Field, Deputy Medical Director 020 7062 1687 rosemary.field@ncas.npsa.nhs.uk Dr Peter Old, Associate Medical Director 020 7062 1643 peter.old@ncas.npsa.nhs.uk Ms Tinku Mitra, Head of Legal Services 020 7062 1649 tinku.mitra@ncas.npsa.nhs.uk Professor Alastair Scotland, Director and Medical Director 0207 062 1652 alastair.scotland@ncas.npsa.nhs.uk Principal points of contact Practitioner Health Programme Dr Clare Gerada, Medical Director Phone 020 3049 4505 php.help@nhs.net Ms Lucy Warner, Chief Executive Phone 020 3049 4504 php.admin@nhs.net 8